Even if you aren't 65, you should still care about Part D

Once the new Medicare drug plan begins, those most affected will be Americans over 65, whose prescription drugs will be covered by the benefit.

But the sweeping change to the nation's primary health insurance for the elderly will affect younger people as well.

"If you aren't 65 yet, most people hope to be," joked Stephen W. Schondelmeyer, professor of pharmaceutical economics at the University of Minnesota. "This is a program that everybody who makes it to 65 will benefit from or be annoyed with, depending what happens to it."

Simply put:

People under 65 could be covered by the new plan if they're disabled.

They may need to understand the benefit to assist parents who are covered.

And, in a broader sense, the Medicare drug plan will affect their wallets - both because the plan is funded by their tax dollars and because it could affect the price of drugs in the larger marketplace.

Taxpayers ought to be concerned about the cost of the program, projected at $593-billion for 10 years, economists said.

"The big problem is going to be financing the whole thing," said economist Etienne Pracht, assistant professor in health policy and management at the University of South Florida. "The cost of this is going to balloon, unfortunately."

The program is so costly that some politicians have said starting it should be delayed to help pay for federal costs of hurricanes Katrina and Rita.

"That's not going to be popular with the elderly," Pracht said. "They still want it to be in place."

Yet the drug benefit could have been cheaper, said Dr. John Meuleman, associate professor of internal medicine in USF's geriatrics division. Taxpayers will spend millions more because the new program forbids the government from negotiating with drug companies for lower prices, Meuleman said. That task will be left to individual plan sponsors, and they will have much less negotiating power.

"It's going to be extremely expensive for taxpayers," he said. "The drug companies are the big winners here."

Whether those prices in the Medicare program will affect drug prices for private insurers and thus for patients not on Medicare remains to be seen. It will take a few years for all the price effects to show, Schondelmeyer said.

"Every player in the market is literally rethinking their role in the market," he said. "How to be positioned in the Medicare market, and how does this affect their other roles . . . it's like a big pharmaceutical chess game."

The Medicare benefit could drive prices up or down, Schondelmeyer said. If a lot of seniors sign up, and competition between plans is fierce, it might drive overall drug prices lower. If few people sign up, companies could hike prices to compensate for what they expected to make from the Medicare benefit.

"I could make credible arguments in either direction," Schondelmeyer said. "There are so many moving parts."